INTRODUCTION:

Alcoholism is one of the major public health problems and world’s third largest risk factor for disease and disability¹. The magnitude of the problem in our country is considerable given that India is the second largest population in the world, with 33% of its population consuming alcohol².

The individuals who are dependent of alcohol report high prevalence rates for becoming involved in arguments while drinking, job related and problems with spouse or someone they were living with³. The presence of individual with alcohol or drug dependence in the family affects various aspects of family like leisure time activities, family and social relationships and finances. Family member's energies become centered on the individual with drug or alcohol dependence which leads to the development of codependence. Their own personal needs, creativity and sexual and aggressive urges were suppressed⁴. Suman LN and Nagalakshmi SV reported that Alcoholic families were characterized by poor communication patterns, lack of mutual warmth and support, spouse abuse and poor role functioning. Among the family members, spouses are particularly affected given the intimate nature of their relationship and the constant exposure to the behavior of the alcoholic⁵.

The wives of alcoholics undergo intense trauma and stress in their domestic environment which brings about major psychological problems in them³. Impairment in husband's financial and legal problems (e.g. arrest, court cases, imprisonment etc.) are the major stresses for the wives of individuals with drug or alcohol dependence⁴. When there is mental break down, the human being grasps at ways of coping with crisis and so does the wives of alcoholics. The term coping has several definitions. According to Lazarus and Folkman (cited by 2004, Mitchell D) coping is constantly changing cognitive and behavioral efforts to manage specific external demands that are appraised as taxing or exceeding the resources of the person. Folkman and Lazarus view coping as having two major and widely recognized functions the regulation of distressing emotions (emotion-focused coping) and doing something to change for the better the problem causing the distress (problem-focused coping)⁶. Emotion-focused coping refers to efforts to manage the negative emotions associated with the stressful situation. These strategies include cognitive distraction, seeking emotional support, emotional regulation and expression, selective attention, and cognitive restructuring. Lazarus and Folkman stated (2011, cited by Eaton PM) that emotion-focused coping is used when events are perceived as uncontrollable, such as health situations. Problem-focused coping is used when the situation is perceived as controllable, such as in work situations. This type of coping is concerned with directly managing the source of stress⁶.

Coping strategies' used by the wives of alcoholics are the concerted efforts both behavioral as well as psychological which are employed by them to master, tolerate, reduce, or minimize the stress associated with their husband's drinking⁷. With psychological well-being comprised, spouses are likely to cope less efficiently; many researchers reported various coping strategies adopted by the wives of persons with alcohol dependence in order to adjust in the family and to overcome the mental difficulties^8,9. Most of the Indian studies suggest that commonest coping strategies are avoidance, withdrawal or fearful withdrawal, sexual withdrawal along with discord, indulgence¹⁰. The frequency of the use of coping behavior by wives of alcoholics was found to be related to their husband's drinking outcome. In general, a high frequency of coping behavior was associated with a poor outcome¹¹. Despite the fact that problem drinking significantly affects families and the community, much of the focus of the treatment is centered on individuals. Mental health of the wives, who form one of the supporting pillars of the family and who seem to bear the brunt of the problems, is a neglected area of research^9,12. The current study aimed to assess the coping strategies used by the spouses of patients diagnosed with alcohol related disorders.

MATERIALS AND METHOD:

A descriptive cross sectional design was employed in the present study. A total of two hundred alcoholic clients' wives were enrolled for the study from using non probability sampling technique. The study was conducted in Psychiatric indoor and outdoor department of Gauhati Medical College and Hospital, Assam, India. 200 wives of patients with confirmed diagnosis of Alcohol related disorders and who were legally married, living with their husbands for last one year were included in the study. Wives of husbands who had history of poly substance use and the wives who drink alcohol by herself or having a history of other substance abuse were excluded in the study.

A pre validated socio demographic proforma is used to collect socio demographic data. It consists of age, religion, education, domicile, occupation, monthly family income, type of family, number of children, duration of marital life etc. To assess the coping strategies Coping Questionnaire tool developed by Orford et al (1976) is used. It consists of 30 items with four-point scale ranging from 0 to 3. The tool yields mean scores in three forms of coping, namely, engaged coping, tolerant coping, and withdrawal coping. Engaged coping is coping by standing up to the problem (14 items), tolerant coping is inactive coping by putting up with the problem (9 items), and withdrawal coping is withdrawing from the problem and gaining independence (7 questions). The mean scores can be obtained by simply summing up the individual items score on each subscale. The score for engaged coping ranges from 0-42, tolerant coping 0-27 and withdrawal coping is 0-24. The high score indicates the higher coping. The tool was translated into Assamese and validated from language experts.

The ethical clearance was obtained from the Ethics Committee of the Institute and permission from departmental authority of hospital was obtained. Written informed consent was taken from each study subject. The data were collected by conducting the individual interview. The wives are explained about the purpose and significance of the study. They were also been informed about the privacy and confidentiality of their informations.

The statistical package for social science (SPSS) 20 versions was used for statistical analysis. Descriptive statistics were done for socio demographic data and Chi square / Fishers exact test were used for inferential analysis.

RESULT:

The socio demographic data ( Table 1 ) revealed that out of 200 wives 56.6% of the wives belonged to 18-34 years of age, 97% belonged to Hindu religion, 34% wives studied upto IX – X followed by 31% matriculate, 80.5% were unemployed, 45.5% had a income of 3001-8000 per month, 81% belonged to nuclear family, 54% were married for less than 10 years, 47.5% husbands of the studied subjects had been drinking for last 11-15 years.

Table 1: Distribution of participants according to socio demographic characteristics ( n=200)

Variables		Frequency	%
Age of wives (years)	18-34	113	56.5
	35-50	85	42.5
	51 and above	2	1
Education level of wives	VI-VIII	40	20.5
	IX-X	68	34
	10^th pass	62	30.5
	12^th pass	19	9.5
	Graduation and above	11	5.5
Religion	Hinduism	194	97
	Islam	4	2
	Christian	2	1
Employment status	Unemployed	161	80.5
	Service holder	26	13
	Self employed	13	6.5
Monthly family income (INR)	Less than 3000	24	12
	3001-8000	91	45.5
	8001-13000	46	23
	13001 and above	39	19.5
Type of family	Nuclear	162	81
	Joint	26	13
	Extended	12	06
Duration of married life	Less than 10 years	112	56
Duration of married life	More than 10 years	88	44
Duration of drinking	Less than 5 years	3	1.
	5-10 years	65	33
	11-15 years	95	47.5
	More than 15 years	37	18.5

Table 2: Mean, median, standard deviation and standard error of mean of the subjects (n=200)

Coping strategies	Mean	Median	Standard deviation	Standard error of mean
Engaged coping	16.4	16	3.22	0.228
Tolerant coping	11.9	12	3.73	0.264
Withdrawal coping	4.1	4	1.29	0.092
Total coping	32.9	33	4.1	0.291

Table 3: Mean percentage of coping strategies (n=200)

Coping strategies	Mean	Possible Range	Mean percentage (%)
Engaged coping	16.4	0-42	41
Tolerant coping	11.9	0-27	44
Withdrawal coping	4.1	0-24	17
Total coping	32.9	0-90	36.56

The mean score (Table 2) of engaged coping, tolerant coping and withdrawal coping is 16.4 (SD +3.22), 11.9 (SD +3.73), 4.1 (SD +1.29). The comparison of mean percentage (Table 3) revealed that the percentage of mean for tolerant coping (44%) is little higher than engaged coping (41%), while withdrawal coping mean percentage is lowest (17%).

Table 4: Association between socio demographic variables and coping strategies (n=200)

Variables

Coping strategies

Engaged

(Chi square/Fishers exact)

Tolerant X²

(Chi square/Fishers exact)

Withdrawal X²

(Chi square/Fishers exact)

Age

1.91

(p>.05)

0.546

(p>0.05)

3.55

(p>0.05)

Educational qualification

10.01*

(p <0.05)

28.6***

(p <0.001)

38.5***

(p <0.001)

Employment of wives

11.2**

(p <0.01)

7.1*

(p <0.05)

6.9*

(p<0.05)

Monthly family income

6.0

(p >.05)

11.2**

(p<0.01)

8.6*

(p<.05)

Types of family

4.3

(p>0.05)

14.0***

(p<0.001)

3.03

(p>0.05)

Duration of married life

0.198

(p>0.05)

1.58

(p>0.05)

1.76

(p>0.05)

Duration of drinking

2.18

(p>0.05)

1.22

(p>0.05)

2.50

(p>0.05)

*Significant at 0.05 level

**significant at 0.01 level

***significant at 0.001 level

Significant association has been observed with educational qualification of wives, monthly family income, employment status of the wives and type of family and various forms of coping questionnaire (Table 4). Type of family is also significantly associated with tolerant coping.

DISCUSSION:

Socio demographic profile shows that majority of the respondents (56.5%) belonged to the age group of 18-34 years, Hindu (97%) in religion, 54% were below matriculate, and 45.5% from lower socioo economic background with a monthly income of 3000-8000 rupees per month.

This study has focused on identifying various coping strategies and their association with other variables. The study discussed three forms of coping i.e. engaged, tolerant and withdrawal coping used by the wives. Wives participated in this study used all these three coping strategies more or less during stressful situations.

The first objective of the study was to assess the coping strategies adopted by the wives of the patients with Alcohol related disorders. The mean value of tolerant coping is 11.9 and it was most frequently used coping strategy among the three coping strategies. The study conducted by Orford et al (1998)¹³ found the mean score of tolerant coping 9.11. The reason of more frequent occurrence of tolerance coping strategy in the present study may be the personality of Indian wives who are basically passive and timid as compared to their western counterparts. The tolerant coping is more or less like self-sacrifice. It is like putting yourself out for him or giving money even if you know they will be spent on alcohol. The adaptive aspect in this coping is that there are minimal arguments.⁷ Majority of the wives (80.5%) are unemployed and they solely depend on their husbands’ income, this also may increase their tolerant behavior. Another reason of high tolerant mean score may be that majority of the wives were at early years of their marriage life i.e. less than 10 years, so they started tolerating their husbands behavior till the time they could. In their study by Sharma N⁷ et al also documented that many a times, in initial few years of problem, the wives begin with tolerant styles.

Engaged coping is a form of coping in which the wife of alcoholic gets vigorously engaged with an alcoholic husband through active interaction maybe by arguing with them to try to get them to stop, throwing away their drinks, telling the user that their behaviour was having a negative effect on them. Engaged coping is the second frequently used coping strategy in the present study. The mean value of engaged coping is 16.4. The study conducted by Orford et al (1998)¹³ found that the mean score of engaged coping was 20.67 which was higher than the present study. This result support the findings of the study conducted by Banerjee I (2017)¹⁴ which revealed that many of the wives of persons with Alcohol dependant syndrome used confronting as coping strategies probably when things go beyond their tolerance level.

The mean value of withdrawal coping in this study has been the lowest among the three coping strategies. The withdrawal coping found in the Orford et al¹³ study was 12.48 where as this study result found a mean of 4.1 for the withdrawal coping. The withdrawal coping involves avoidance of the drinker, active involvement in other self-regulating activities and gaining independence. Orford et al¹³ identified the few elements to ‘gaining independence’ i.e. not worrying, doing what the family member wants to do, getting involved in other activities, escaping or getting away, sorting oneself out, and getting a new and better life for oneself and other members of the family. In west, more of withdrawal coping is prevalent as women are more autonomous and have enough community resources to engage self away from the alcoholic partner while in Indian set up, it is either more of engaged or tolerant coping styles. The present study supports the finding of the study conducted by Banerjee I (2017)¹⁴ which revealed that escape avoidance was less frequently used coping strategy. On the contrary most of the studies conducted across the globe reported escape or avoidance as the most used coping strategy to deal with their alcohol dependent husbands.¹⁴. Indian studies also releaved similar findings.^{15, 16, 17,}

The present study revealed strong significant association with some of the demographic variables of the wives and the coping strategies. The educational qualification and employment status of wives, monthly family income and types of family has been significantly associated with the coping strategies. Similarly, a study conducted by Meenakshi (2003)¹⁸ highlighted the signification association between coping and income, duration of disease and type of family. Revathi S (2009)¹⁹ also found a signification association between coping style of wives and family income. On the contrary Chandrasekaran R and Chitraleka V (1998)¹⁶ found no correlation with educational status of wives and coping style, Rao S and Kuruvilla K (1992)¹⁷ reported no correlation between the coping behaviours and the variables like duration of marriage, duration of husband's alcoholism, socio-economic and educational status. The present study revealed no significant association between age of wives and duration of drinking of husband. This study finding is consistent with the result of the study conducted by Chandrasekaran R and Chitraleka¹⁶ V (1998).

Offord et al. (2001)²⁰ conducted a study among relatives facing drug and alcohol problem in Maxico and England revealed that tolerant coping behaviors were found to positively correlate with a measure of physical and psychological symptoms in the person trying to cope. It suggests that this way of coping is not adaptive for family members. Therefore the high levels of tolerant coping behaviors seen among the wives in the current study suggest that the respondents may be suffering from poor physical and psychological health. There is a need for further evaluation in this aspect.

Low withdrawal behaviors and high levels of engaged behaviors among the wives suggests they are not disengaged from their husbands. Therefore their coping behaviors may be linked to a positive prognosis, moreover the wives also accompanied their husbands which also reflects as a part of engagement process.

CONCLUSION:

Majority of the wives of alcoholics used all three coping strategies to deal their husbands’ drinking problem. But the percentage mean of tolerant coping was higher compare to the other two coping strategies. As the tolerant coping is associated with the poor psychiatric heath among the caregivers there is a need to strengthen the healthy adaptive coping strategies among the wives and help them to perceive the stressful situations as manageable. The study also concluded that the variables like education and employment status of wives are significantly associated with the coping strategies. Strengthening in these areas may help the wives to adopt better coping strategies. Knowledge of adaptive coping strategies can be used in the prevention of distress and the promotion of mental health. Perceived social support, cultural upbringing and personality profile of wives may be other influencing factors which may be associated with the coping styles of the wives of alcoholics.

CONFLICT OF INTEREST:

None.

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Received on 04.11.2018 Modified on 03.12.2018

Int. J. Nur. Edu. and Research. 2019; 7(2):237-241.

DOI: 10.5958/2454-2660.2019.00051.6